Provider Demographics
NPI:1144687716
Name:MOHAWK MONTY
Entity type:Organization
Organization Name:MOHAWK MONTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZAJACESKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-842-6701
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-0365
Mailing Address - Country:US
Mailing Address - Phone:518-842-2990
Mailing Address - Fax:
Practice Address - Street 1:10 CHURCH STREET #365
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-0365
Practice Address - Country:US
Practice Address - Phone:518-842-2990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies